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Cideous

Identifying the Pain: A providers cautionary tale for all of us...

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PA, about 8 years into a corporoate urgent care career.  She was a good provider who stayed very close to the the standard of care.  Single, but in a relationship, otherwise unremarkable.  When she was fired on the spot it was a shock to us all.  Turns out she was a heroin addict who would spend 45 minutes in the bathroom only taking a little black bag in with her.  She would shoot up, then return and see patients.  "The only thing that tipped the clinic staff off was the amount of time she spent in the bathroom.  The clinic medical director struggled with the option of sending her to rehab, but in the end, decided to just cut her loose.  No help, no follow up...just gone.  They were worried about google and yelp reviews and liability should the general public find out.  I can't say that I blame them but ouch, that must not of been an easy call.

The cautionary tale is this:  If you take mind altering meds, they will affect your work.  If you take these meds, they will eventually catch up with you and destroy your career as it did hers.  Don't start with them....ever.  Find another way.

Let this be a cautionary tale.  We are all human and none of us are immune to addiction.

 

What/who is your cautionary tale?

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When I was in anesthesia there was a faculty member at a different, but same city, program who was put on probation for over a year for abusing propofol. License suspended as well. Went through rehab, got her license back, got her faculty job back. One week on the job she was found dead in the bathroom with a bottle of propofol. Addiction is a powerful thing.

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I have seen provider patients who are on the state monitored rehab program and have to report everything. They have appeared grateful for the chance to get their licenses back or keep it with restriction - they seemed motivated.

Hate to hear that anyone loses the battle with an addiction. Always wonder how they got there in the first place. 

Firing that provider increased despair and eliminated a lot of options - I think folks deserve at least one chance to participate. 

Hope that PA has support somewhere and feels strong enough to let someone help.

Sad state of affairs

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37 minutes ago, Reality Check 2 said:

Always wonder how they got there in the first place. 

 

That is exactly my point in this thread.  Do not start.  Ever.  If you do, it will be your demise sooner or later.

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I feel for this provider. Hopefully she can get some treatment for her SUD. Addiction does not discriminate.  

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In 2012 I tore my rotator cuff and labrum lifting a patient.  No big deal, great surgeon fixed me right up.  

On discharge, I was given a bottle of 90 Oxycontin 20mg tabs, take 1-3 q6h PRN, with no instructions beyond that.. I swore I wouldn't touch them, then the block wore off and I slammed 3 because that day SUCKED.  Over the course of the next 2 months or so, I consumed every single one of those oxycontin, initially because I was in excruciating pain, then it was just because I was sore.. In every instance, the opium took every bit of my pain away and made me feel absolutely marvelous.  It took me a very long time to not crave those pills when that bottle ran out.

I remember that time in my life vividly, and I use it to ground me when I'm dealing with folks who have become addicted.  Because by the grace of God, I only had 1 ounce more self-control than they did.  That single ounce of self control is what kept me from finishing off that legal bottle, buying an illegal bottle, and eventually devolving into heroin as so many have done before me.

Edited by FiremedicMike
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33 minutes ago, FiremedicMike said:

In 2012 I tore my rotator cuff and labrum lifting a patient.  No big deal, great surgeon fixed me right up.  

On discharge, I was given a bottle of 90 Oxycontin 40mg tabs, take 1-3 q6h PRN, with no instructions beyond that.. I swore I wouldn't touch them, then the block wore off and I slammed 3 because that day SUCKED.  Over the course of the next 2 months or so, I consumed every single one of those oxycontin, initially because I was in excruciating pain, then it was just because I was sore.. In every instance, the opium took every bit of my pain away and made me feel absolutely marvelous.  It took me a very long time to not crave those pills when that bottle ran out.

Jesus lord, oxycodone 40mg #90? That's insane. When I started as a new grad 4 years ago in ortho the surgeon was giving everyone percocet 10/325 #60 and I thought that was bad. I've worked with him to really bring this down. Now we do Norco 5/325 #28 for scopes and 10/325 for open cases (usually totals). Even with this substantially lower dosage most people don't need a refill and can get buy with OTC pain meds. If they need a refill, we'll do one. After that, I try to wean them down to OTC or tramadol. 

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1 hour ago, AbeTheBabe said:

Jesus lord, oxycodone 40mg #90? That's insane. When I started as a new grad 4 years ago in ortho the surgeon was giving everyone percocet 10/325 #60 and I thought that was bad. I've worked with him to really bring this down. Now we do Norco 5/325 #28 for scopes and 10/325 for open cases (usually totals). Even with this substantially lower dosage most people don't need a refill and can get buy with OTC pain meds. If they need a refill, we'll do one. After that, I try to wean them down to OTC or tramadol. 

I’m sorry I’ve been thinking on it and I do believe they were 20mg, not sure that makes it a whole lot better...

edited my original post for accuracy..

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54 minutes ago, FiremedicMike said:

I’m sorry I’ve been thinking on it and I do believe they were 20mg, not sure that makes it a whole lot better...

edited my original post for accuracy..

Still, that's huge.  The Ortho's around here never give more than 5 mg Oxycodones, although they're quite likely to give #60 if it's a big surgery.

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remember it's not just opiates, there are plenty of providers walking around who are functional alcoholics until it all comes crashing down when they get a DUI, have a big accident, or show up obviously drunk at work. Have seen it. 

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My husband became dependent on alprazolam.  It was prescribed when he had a panic attack while driving a shuttle bus.  This was in the early 1990's before I was a PA.  There is a family history of anxiety and alcoholism in his family.  He needed escalating doses and his physician was more than accommodating.  When I went to PA school I learned about the BZD's.  It took us a long time to find a physician who would taper him and one in fact said he would but wrote for even MORE tablets in the tapering schedule.  I challenged that and that physician soon retired (wonder what he was taking?)  My DH got put on an SSRI finally by a physician who hated alprazolam and the BZD's and by about 2010 he was off it and on his SSRI.  I often wonder if my husband's long term use of alprazolam impacted his diagnosis of early onset Lewy Body dementia (along with his addiction to diet Mountain Dew and the crap in diet drinks?).

Consequently, I rarely prescribe BZD's and have long discussion with patient's about counseling, SSRI therapy, alternate treatments for anxiety , and do a really in-depth history of SUD in my patients.  

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